天津市区级结核病防治定点医院模式实施效果分析

Analysis on the Effect of Implementation of District-level Tuberculosis Designated Hospital Model in Tianjin

目的分析天津市区级结核病定点医疗机构由结核病防治所向定点医院转变前后结核病防治工作主要指标的变化情况,为进一步完善结核病防治服务体系提供理论依据。方法数据来自于结核病管理信息系统,对天津市新型结核病防治服务体系模式转型前(2012-2013年)和转型后(2016-2018年)结核病主要指标的变化情况进行统计描述。采用SPSS 17.0软件进行分析,率(构成比)比较采用χ2检验,以P<0.05为差异有统计学意义。结果转型地区的区级结核病定点医疗机构初诊患者平均登记率(转型前后分别为69.42/10万、78.28/10万)、活动性肺结核患者平均登记率(转型前后分别为17.18/10万、20.01/10万)、新涂阳肺结核患者平均登记率(转型前后分别为6.46/10万、7.36/10万)、活动性肺结核患者因症就诊的比例上升(转型前后分别为50.47%、76.20%),且差异均具有统计学意义(χ2=26.04、10.48、9.85、131.07,P<0.05);而非转型地区的区级结核病定点医疗机构,以上指标虽有所上升,但除初诊患者登记率(转型前后分别为43.30%、49.8%)外差异均无统计学意义。转型区转型后初诊查痰率(转型前后分别为98.41%、88.28%)、新涂阳肺结核患者治愈率(转型前后分别为96.47%、85.24%)和涂阴肺结核患者的完成治疗率(转型前后分别为97.92%、92.71%)均下降,且差异均有统计学意义(χ2=278.11、23.650、15.100,P<0.05);而非转型区,转型前后时间段内以上3个指标虽也有所下降,但差异无统计学意义。结论天津市区级实施结核定点医院模式后,确诊肺结核患者的发现水平有所提高,但肺结核患者的管理工作亟待改进。

Objective To analyze the changes of the main indicators of tuberculosis(TB)prevention before and after the transformation from TB prevention and control institute to designated hospital model in Tianjin,so as to provide theoretical basis for further improving the TB prevention and control service system.Methods The data about main indicators of TB prevention were collected from the TB management information system.Descriptive analysis was conducted on the changes of main indicators of tuberculosis before(2012-2013)and after(2016-2018)transformation of new tuberculosis control service system model.The SPSS 17.0 software was used for statistical analysis,and a two-sided P<0.05 was considered statistically significant.Results After the transition period,average registration rate of patients with initial diagnosis in transitional areas(69.42/105 before transition vs.78.28/105 after transition),average registration rate of patients with active TB(17.18/105 before transition vs.20.01/105 after transition),average registration rate of newly smear-positive patients(6.46/105 before transition vs.7.36/105 after transition),and the proportion of patients with active TB have been increased(50.47%before transition vs.76.20%after transition),and those differences were statistically significant(χ2=26.04,10.48,9.85,131.07;all P values<0.05).Although the above indicators have risen in the areas without transitional model,there is no statistical significance except for the registration rate of first-time patients(43.30%before transition vs.49.8%after transition).Similarly,the rate of sputum detection at initial examination in transitional areas(98.41%before transition vs.88.28%after transition),the rate of curing for newly smear-positive TB patients(96.47%before transition vs.85.24%after transition)and the rate of completion of treatment for smear-negative pulmonary TB patients(97.92%before transition vs.92.71%after transition)have been decreased,and those differences are statistically significant(χ2=278.11,23.650,15.100,all P values<0.05).The above three indicators also decreased in the areas without transitional model,but those differences were not statistically significant.Conclusion After the implementation of designated hospital model in five districts of Tianjin,the level of TB detection has been improved,but the diagnosis,treatment and management of TB patients still need to be improved urgently.